Ask the expert: Angela Walsh

Welcome to ReachOut.com’s Ask the Expert service

Through this service the ReachOut.com team will be working with a group of professionals and experts with detailed and specialist knowledge of youth mental health issues such as anxiety and depression to answer your questions and address your concerns. The issues covered will be the same as those covered throughout ReachOut.com but through this service we will be able to provide valuable insight into more specific and personal concerns that you may have.

This month

Each month we will concentrate on one particular mental health area and work, mainly, with one specific collaborator. This month our featured expert is Angela Walsh who is the clinical nurse manager from Willow Grove taking your questions about anxiety and depression.

Questions and answers

We won’t have all the answers to every question – but we do have access to the best available information, so let us know what’s on your mind by submitting a question here.

Your question and answer from Angela will be published here at the beginning of each week, so you may wait up to a week for an answer.

The advice provided through this service is not intended to replace face-to-face professional advice or any on-going support that a person may be receiving. If you or someone you know is in crisis now you should go to emergency support information.

Jane says:
Hi, My names Jane and I experience alot of anxiety when it comes to reading aloud in class or public speaking. I am really afrain because I have english class tomorrow and I will be made to read out my answer.

Hi Jane,

I am really glad that you have taken the first step by contacting us here and putting your worry into words, well done for taking that first step.

It sounds like your anxiety has been building up over a period of time and it is making your school life miserable. You probably find that the worry of when you are next going to be asked to read out loud in class is taking up a lot of your headspace and may be affecting your ability to fully concentrate on what is being taught.

When we are anxious about a situation such as speaking aloud in class or being put on the spot with everyones attention on us, we may start to experience very negative thoughts about that situation such as …everyone will be looking at me, what if my mouth dries up or I cant think of the answer, or my voice is wobbly and we start to dread the situation and think of the worst case scenario.

When we have thoughts like this it can affect us physically as well, for example we might feel sick in the pit of our stomach, have sweaty hands, feel our throat go dry, heart beating faster, breaths shallower and faster. It can then happen that we try to avoid the situation which as you say is difficult as you don’t want to skip classes so you may be trying to avoid the teachers eye or are spending time thinking about how to avoid the situation. If it does arise you are then so nervous and worked up your chances of doing well in reading may not go so well and this increases your anxiety and you worry about the next time and so the vicious cycle of anxiety continues. You may be starting to believe that this will always be the case.

However it does not have to be, anxiety can be managed and you have taken the first step by recognising that it needs to be tackled now because as you say you have a year of school left and you want to give yourself the best chance of enjoying it to the full. We cannot live our life without having some anxiety in it but what we can do is to learn to recognise what anxiety is, how it affects us and how we can respond in a different way to it.

You have stated that you were happy in the past and no doubt in the past you had some situations that would have made you anxious. Can you think about what those situations were and how you were able to manage them and notice what is different about the way you are thinking about the current situation. The important thing to remember is that you have managed situations that are anxiety provoking in the past and with the right help you can do so again in the future.

There are some very practical things that you can do to help manage your anxiety. Learning breathing and relaxation techniques can be helpful and can be used when you notice that you are starting to get anxiety symptoms. These take practice but are worth persisting with. Getting plenty of rest and having a good diet as well as having plenty of exercise is also useful. When we feel anxious our glands produces adrenaline into our bodies and this makes our muscles tense and our heart beat faster. When we exercise the adrenaline is expelled, the muscles relax and the heart rate slows. Regular exercise is a good way of releasing tension and helps keep anxiety at a more manageable level. There are lots of different self help books on anxiety available. One that I like is The Anxiety Workbook for Teens by Lisa M. Schab which gives a good overview of how anxiety affects us and gives lots of activities that you can try out to help you overcome anxiety and worry.

The first step I suggest you make is to talk to an adult that you trust, either a parent or a teacher and tell them what you are feeling and that you would like some help to overcome it. Sometimes just by talking about what is making you anxious and having someone listen and offer support can be hugely helpful.

It may be that you are feeling quite overwhelmed with anxiety at the moment and it may be useful to get help from a professional who deals with anxiety and your GP will be able to recommend someone in your area. Talking treatments are recommended for anxiety and there are different types of counselling and psychotherapy which can help you to understand and cope with anxiety. Cognitive behaviour therapy is recommended as a treatment for anxiety which helps you to learn new ways of thinking, and to develop practical coping strategies for managing anxiety. If you want to find a cognitive behaviour therapist or psychotherapist you can check out the following websites www.psychotherapy-ireland.com. ( for psychotherapists) http://tnmracing.com/nacbt/therapists.php( for cognitve behaviour therapists)

The best of luck.

Angela

Zoe says:
today i had a anxiety attack, it lasted for 1 hour and ten minutes is this normal? and if it happens again should i seek medical advice? i suffer from depression and anxiety its just it never lasted that long before and it was worse then any i have ever had.

Hi Zoe,

Unfortunately there is no exact answer to this. Most anxiety attacks last between 5 and 20 minutes but some people can experience them for a longer period. Sometimes one attack can run into another or you may find that you are highly anxious for a period after the initial attack and it takes a long time for the symptoms to subside.

If you are finding that the attacks are more frequent or lasting longer i would return to your GP or therapist and seek his/her advice. It can be reassuring to have a physical check up to outrule any other physical causes. You may need to revisit or refresh the anxiety management strategies that were recommended to you and explore if there is anything more that you can do to ensure that you are as relaxed on a day to day basis.

Sometimes anxiety attacks can arise out of the blue or they may be triggered by stressful events. It is worth looking closely at what is going on at the moment to see if there are any ways of reducing possible triggers to your attacks and reducing daily stress. When you have had an attack that is unusual in its presentation for you, it is understandable that you would worry about it occurring again and this can trigger a cycle of worry and anxiety.

Its important to remember that you have had anxiety attacks in the past and have managed to get through them, they are very unpleasant to experience them but what helps is to recognise what is happening in the moment and to name the feelings and sensations as anxiety and tell yourself that you have managed it before and that it will pass.

Good luck

Angela

Ola says:

Hi there,

I have a problem. my best friend ask me for help, as he trusts me and knows that I want all the best for him. I have been asked by him to help in a research related doctors, therapists, psychologists – who will be the best to contact with and help him with his problems.

He said: I am aware that I have a problem, I just can’t feel anything- happiness, love… what does it mean? I am not a happy human being! Everything started when I was a kid, I am the only child and I always wanted to be accepted by my dad, I have never heard that he was proud of me or that he loves me, nothing, absolutely nothing. Since then, I am trying to proof myself (my dad) that I am worth something. I left a family home when I was a teenager, bacame a father when I was 19years old, got married and then divorced in couple years time , I just couldn’t handle family life, routine, it was too much, I was really struggling. One day I have packed my backpack and that was it! Never came back! I love my 14years old doughter and I am in touch with her, mostly over the phone and maybe twice a year I am getting chance to see her (he doesn’t live in the same country).
Then I met a girl which I was engaged to, we were together for 7 years and then I cheated on her. She suffered, I broke her heart, can’t forgive myself. Since then I can’t be in a loving relationship, every time I feel like I have to pay back what I did or sacrifice something. I know that I like women and can manipulate them , don’t really have any male mates. When something goes wrong I am running away, it is the easiest way to do, can’t deal or solve problem. Can’t settled down, I am afraid of commitment. Can’t say what I want!!!

I am living in the past, can’t accept it and move on. When I am feeling down I start drinking, that cures everything.I am scared of big crowds of people, but I am not scared of going by myself to Sahara or jungle and meeting people over there.I really want to accept myself, people to accept me. Please, HELP!

This is what I heard. In my opinion there is much more to add to this story, but overall…

He keeps running, can’t stop, can’t find balance in life!

How can I help him? Who should I tell him to contact with?

Please HELP.

Regards

Ola

HI Ola,

You are already helping your friend by being supportive and listening to him. It sounds like as well as having you as a support your friend might benefit from talking to a professional therapist who will be able to help him explore and make sense of the difficulties he has had in the past and the current difficulties you describe.

Your friend is being quite hard on himself and needs someone who will help him to understand the patterns in his life, the possible origins of his current difficulties and explore ways of going forward. I would suggest that if your friend is willing to get help that he attend a professional therapist such as a psychologist or counsellor who will be able to assist him. I would suggest that he contact the Psychological Society of Ireland, phone 01-4720105, website: http://www.psychologicalsociety.ie/ or the irish association for counselling and psychotherapy (IACP) http://www.irish-counselling.ie/ for a list of professional therapists.

Your friend may not be willing to attend therapy at the moment but you can give him the contact numbers and encourage him to attend when he feels ready to do so. Try to engage him in enjoyable activities that don’t involve alcohol if he is drinking heavily and encourage him to get out and about and to look after his physical health by eating and sleeping well. A good website with information on alcohol misuse and a listing of services that specialise in this area is http://www.drugs.ie

You are already helping your friend by being there for him and caring for him enough to contact this site. Make sure that you also take care of yourself and have someone that you can get support from as well.

All the best

Angela

Zoe says:

Hi, my best friend keeps having breakdowns, anziety attacks and is always trying to ide the fact she is depressed by hiding behind giddy behaviour and being to happy for anyone to cope with i try to help her and be there for her but there isn’t much that i know to do to help her i rub her back when she is sick and am a sholder to cry on when she needs it she also has refused to eat normal meals for the last year or so just eating little bits every now and then because people are worried and start shoving food at her i now this is bad but when my friend gets and idea in her head i can’t make her budge what can i do to help her she ends up scaring me because i’m scared for her

Hi Zoe,

Thanks for getting in touch with us. It sounds like your friend is having a tough time and you are doing your best by trying to support her. You are being a great friend by being there and giving her support and a shoulder to cry on.

It really helps people when they are feeling down to have someone they can share their problems with and who will listen in a kind and supportive way. However it sounds like you are really worried that your friend might need more help than you can provide and if she is eating very little and her behaviour is scaring you, then it is time to get some support for both yourself and your friend.

Try talking to your friend and letting her know that you are worried about her and encouraging her to talk to someone and reiterate to her that there is lots of help available. Your friend may not want or feel ready to get help and may even be a bit angry with you for suggesting this. Just keep reminding her that you care for her and are there for her and that she doesn’t have to cope with things on her own. I think you should share your concerns with an adult such as your parent or perhaps the guidance counsellor in school and let them know what in particular about your friends behaviour is worrying you and ask for their advice and support. It will be a relief to you to share your worry and talk to someone about your concerns.

Angela

Cait says:

I experience anxiety and depression and have had with the last year or more. I am currently doing my leaving cert and find myself generally more anxious in school especially. I avoid large crowds and hate going out with my friends.

I am currently on antidepressants and have had months of counselling but I cant help felling hopeless, and there is no escape

Hi Cait,

I am sorry to hear that you are having such a difficult time at the moment but I am so glad to hear that you have already sought and are getting support in helping to manage your anxiety and depression. Don’t give this up. It takes courage to seek help and to try out different strategies that may be suggested for managing anxiety.

You have obviously put a lot of effort in going to counselling over the last year and I would encourage you not to give up on this and to take small steps at a time. Overcoming anxiety is sometimes not as straight forward or as easy as we would like it to be and there may be days or times when it is harder than others. What might be helpful to realise is that our individual responses to anxiety take time to develop and it does take time to change our patterns of thinking about situations that trigger our anxiety and challenge negative thoughts and worry that fuel anxiety.

It can be very frustrating when we are trying ways of managing anxiety that work one day and then don’t work the next. What can happen then is that our confidence in our ability to manage that situation is knocked and we slip back into the old way of fearing anxiety provoking situations, having negative thoughts about them, predicting and fearing anxiety reactions and if they occur, going out of our way to avoid situations. It sounds like this might be what’s happening at the moment and this can be especially difficult if you are feeling depressed as well.

The return to school can be a difficult time and can trigger a resurgence of anxiety symptoms and you may be feeling overwhelmed at the moment. I am sure that over the time that you have been getting counselling there have been good days and bad days and that you have won some battles with your anxiety. Try to hold on to the successes and the progress that you have made.

What struck me about your email is that you have been feeling anxious and depressed for over a year and I imagine that you will have been worrying about school return over the summer. Yet you have managed to go back to school which is a great achievement and a really positive hopeful step, you hate going out with your friends yet you don’t say that you have stopped this. Well done you! You may not have overcome anxiety completely but you are chipping away at it. Keep up the contact with your friends and use them and your family for support. Let your counsellor know how you are feeling at the moment and make an appointment to see your doctor if you feel your mood is getting lower. Practise any homework or strategies that your counsellor suggests to you and let him/her know what is working well and not so well and review your plan together.

All the best,

Angela

Paul says:

Hello there I think I may have suffered my first Panic Attack a few days ago I was in the hospital for a diagnosis and they asked me if I was an anxious person I believed I wasn’t but after reading your list of the symtoms of anxiety I recognised most of the points I have to go back to the hospital should I mention all this.

Hi Paul

Yes, if you are returning to the hospital it would be very useful for the team looking after you to have as much information as possible, so that they can make the most informed decision about your diagnosis and treatment. It would be useful for the doctors to know what symptoms you have been experiencing, how long you have been having them, what makes them worse or relieves them. When someone presents with symptoms of panic attacks they can be similar to symptoms of other conditions and the medical team look at all the possible causes to out rule any underlying physical illnesses.

Angela

LukeSays:

i am feeling very lonely and misunderstood i am showing some signs of depression but just try to appear happy what should i do ?

Hi Luke

, thanks for getting in touch with the site. I am guessing that it is a struggle to keep up the pretence of trying to appear happy when inside you may be feeling very sad or feeling a mixture of emotions. In my experience i have found that this can be quite a common way that people try to cope when they are feeling depressed. This might be for a number of reasons, perhaps being afraid that people won’t understand or not wanting to be a burden to other people or struggling to understand the different emotions you are feeling yourself.

Sometimes when you are depressed you can feel overwhelmed with emotions going from being sad, frustrated, angry to sometimes not being able to feel any emotion at all. You may find that your mood is low most of the time or there are times in the day when it is worse than other times. You may worry that if you start to talk about it you might become tearful or upset. Bottling things up can work in the short term but can make you feel frustrated and angry and ultimately people may sense that all is not well with you but may not understand why this is and wonder why you are not your usual self.

When we are feeling low, we may not have the same energy or interest in things that we normally do and may find our concentration and drive is diminished. Friends and families may misinterpret this as lack of interest or effort or can attribute it to adolescent “hormones” and can sometimes respond to you in a way that is not helpful and can make you feel worse. This can lead you to become isolative and I wonder if this is happening to you and contributing to making you feel lonely and misunderstood.

From my own work with families of young people who experience depression, the thing parents and family very often say is that they didn’t realise that their son/daughter/brother/sister was feeling low in mood and wonder why they didn’t tell them earlier. You may not think so at this moment but the first step to feeling better is to share how you are feeling and talking to someone. This can be hard to do at first, so take it at your own pace, choose someone who you feel comfortable talking to and who you know will want to support and help you and just use your own words to describe how you are feeling. It can be such a relief to get feelings out and to have someone to look at things with us and give us a different perspective. Its important to remember that we can go through periods of feeling down when we feel nothing is going right for us without necessarily having depression . This might be because of pressure at home, school or in relationships or may be because we have had a bereavement or illness. Sometimes a number of things can all go wrong at the same time and make us feel really fed up. Check out the section on this site “feeling crap” . It gives some very good tips on what to do that might help you get through tough times, https://ie.reachout.com/inform-yourself/depression/feeling-crap/

If you find that the feelings you describe are getting worse and your mood is not lifting I would encourage you to go to your GP who will be able to advise on treatment of depression and if necessary refer you on to a professional with expertise in this area.

The best of luck.

Angela

Raymond says:

Hi, i have social anxiety disorder and very low self esteem, decided recently to get help about it because it has held my back for so long. i wish there was more awareness and help out there, when i talk to strangers or people i have just met a few times, which is not a lot, they look at me as if there is something wrong me, just wish i could shake this off, i am 23 and have wasted so much time with this and i do get very down about it, spend most my time in the house

Hi Raymond

I am really glad to hear that you have made the decision to seek help for your anxiety. That is a really positive step and is the start of a new beginning for you and the start of you rebuilding a different life for yourself. Think of that step as the first building block in your recovery, a foundation so to speak. This will need to be built on and it does take time.

I suggest that you find out everything you can about anxiety and how it works and how it affects your thoughts and emotions, how it affects you physically and the ways it affects your behaviour. By recognising the pattern of anxiety that is specific to you will help you to recognise the different elements maintaining it as they come, and this will help you to recognise and deal with the specific thoughts or emotions as they arise rather than letting them build up and develop.

Its important that you recognise the times when you have mastered anxiety and focus on these rather than on the times when it was hard to manage. This is easier said than done as unfortunately we can tend to be our own worst critics and give ourselves a hard time.

Try not to do everything at once, take it slowly and build up your ability to manage anxiety provoking situations. You may find it useful to look at a hierarchy of situations that are stressful for you and try to master the easiest ones first. If you are getting professional help your counsellor or therapist will help you to work on this.

When you have a difficult day or a set back, name it as such and catch yourself when the negative thoughts start to creep up on you and do your best to let it go.

Try out lots of different ways of relaxation and build them into your daily maintenance plan. There are lots of useful tips on this here on this website. It is easy to get caught up in the “what ifs” and “if only” and this can lead us into a negative thought pattern which is not helpful so try to leave the past in the past and concentrate on the more proactive steps you have taken to change your life.

You are right in that there is a lot more that could be done to create awareness around mental health and increase people’s knowledge of the many services that are there to help. This website and positive mental health campaigns are doing their bit in trying to create awareness but a lot more can and needs to be done. See the Get Involved section of this website for ways of creating awareness of mental health issues and promoting positive mental health if this is an area that interests you.

Take care and the very best of luck for the future.

Regards

Angela

leslie says:

good morning, can you please reccomend a bullying specialist that i can contact to bring my 15 year old godson to he is being badly bullied in school , we live in dublin, thank you for your help

Hi Leslie

Thanks for getting in touch and I am sorry to hear that your godson has been having a hard time through bullying. I would recommend that you contact the Irish Association of Counselling and Psychotherapy at 21 Dublin Road Bray co Wicklow . Their phone no is 01-2723427 and their website is http://www.irish-counselling.ie/ . They will provide you with a listing of accredited counsellors who will be able to help your godson with dealing with the effects of bullying.